<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
	pageEncoding="ISO-8859-1"%>
	<%@include file="../common/common.jsp" %>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Make Payment</title>
</head>
<body>
	<%-- <jsp:include page="../common/header.jsp"></jsp:include>
	<jsp:include page="../common/leftpan.jsp"></jsp:include> --%>

<jsp:include page="../common/commonHeader.jsp"></jsp:include>

	<div class="body2">
		<div class="main">
			<!-- Content -->

			<div class="marg_top wrapper">

				<div class="text">
					Dear Customer, In order to become an active member of our
					application and gain access to the services provided, you need to
					pay an amount of Rs. 1000/-.


					<form action="customerPayment.action" method="post"
						style="width: 400px;">
						<table>
							<tbody>
								<tr>
									<td colspan="2"><h4 class="commentformTitle">Please
											fill the payment Details....</h4> <input type="hidden" id="postId"
										name="postId" value="11" /></td>

								</tr>
								<tr>
									<td class="row"><label for="visitorFirstName">CardHolders
											Name </label></td>
									<td class="row"><input type="text" id="loginName"
										name="cardHolderName" class="short"
										placeholder="Name appear as on card" required="" /></td>
								</tr>
								<tr>
									<td class="row"><label for="visitorLastName">Card
											Number</label></td>
									<td class="row"><input type="text" name="cardNumber"
										class="short" placeholder="7897797878799" required=""
										size="16" /></td>
								</tr>
								<tr>
									<td class="row"><label for="visitorLastName">Card
											Type</label></td>
									<td class="row"><select name="cardType" required="">
											<option>Select card type</option>
											<option value="master">Master</option>
											<option value="credit">Credit</option>
											<option value="visa">Visa</option>
									</select>
								</tr>
								<tr>
									<td class="row"><label for="visitorLastName">Expiry
											Date</label></td>
									<td class="row"><select name="month">
											<option selected="selected">Month</option>
											<option value="jan">Jan</option>
											<option value="feb">Feb</option>
											<option value="march">Mar</option>
											<option value="april">Aprl</option>
											<option value="may">May</option>
											<option value="june">June</option>
											<option value="july">Jul</option>
											<option value="aug">Aug</option>
											<option value="sept">Sept</option>
											<option value="oct">Oct</option>
											<option value="nov">Nov</option>
											<option value="dec">Dec</option>
									</select> <select name="Year">
											<option selected="selected">Year</option>
											<option value="2012">2012</option>
											<option value="2013">2013</option>
											<option value="jan">2014</option>
											<option value="jan">2015</option>
											<option value="jan">2016</option>
											<option value="jan">2017</option>
											<option value="jan">2018</option>
											<option value="jan">2019</option>
											<option value="jan">2020</option>
									</select></td>
								</tr>
								<tr>
									<td class="row"><label for="visitorLastName">Cvv
											no</label></td>
									<td class="row"><input type="cvvNo" name="cvvNo"
										class="short" placeholder="***" required="" size="3"
										style="width: 50px;" /></td>
								</tr>

								<tr>
									<td class="row"><label for="visitorLastName">Pin
											no</label></td>
									<td class="row"><input type="password" name="pin"
										class="short" placeholder="****" required="" size="4"
										style="width: 50px;" /></td>
								</tr>
								<tr>
									<td class="row">&nbsp;
										&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td>

									<td class="row"><input id="submitBtn" type="submit"
										value="pay" />&nbsp;&nbsp;&nbsp;&nbsp;<input id="submitBtn"
										type="reset" value="Reset" /></td>
							</tbody>
						</table>

					</form>

				</div>

			</div>
		</div>
	</div>

	<jsp:include page="../common/commonFooter.jsp"></jsp:include>

</body>
</html>